opportunities

Health economics

This project aims to evaluate the health economics of disseminating the low risk clinical pathway across cancer services nationally.

Primary supervisors: Kim Dalziel

In disseminating the low risk clinical pathway across cancer services nationally this project will develop an implementation tool kit that will include organizational readiness assessment, resource planning and clinical pathway documents (initial assessment and inclusion criteria, risk assessment, suitability for oral antibiotic switch, suitability for discharge, and pathway management by the HIH service and nurse coordinator). All sites adopting the program will be enrolled in a health economic evaluation and a patient and clinician experience and outcomes study. Costs will be measured for outpatient and inpatient health care service use including actual inpatient costs of each FN episode including bed-days, medications and investigations, and costs for outpatient service use will be captured by accessing records for medical (MBS) and pharmaceutical services (PBS).

Informatics

This project aims to deliver an integrated single point of access system that provides real time surveillance of invasive fungal infection, streamline use of antifungal agents and risk stratification.

Primary supervisors: Prof Karin Thursky and Prof Karin Verspoor

We aim to pilot our electronic fungal management system in 180 transplant patients nationally. The system will be a world first in medical informatics and will form a base from which to subsequently include surveillance and management of other hospital acquired infections with enormous commercial potential. We have mapped workflow and processes relating to infection management within haematology wards and found duplication of data collection tasks, data held in silos and not easily available and a poor overall understanding of risk assessment, drug interactions and therapeutic drug monitoring by junior doctors tasked with patient care. This system addresses these workflow problems whilst providing a single data source relating to fungal infection history, risk, guidelines as well as collecting data and refining risk assessment with machine based learning.

Paediatrics

This project aims to improve antimicrobial stewardship in children.

Primary Supervisor: Karin Thursky

The European-based Predicating Infectious Complications of Neutropenic sepsis In Children with Cancer Collaboration (PICNICC) has developed an algorithm to stratify children into low and high risk for complications associated with FN which will facilitate early identification and safe treatment in the outpatient setting or with oral antibiotics (1). Through collaboration with established research networks including Paediatric Integrated Cancer Service (PICS), Australian and New Zealand Children’s Haematology and Oncology Group, we have begun a project to validate and update the PICNICC algorithm in 8 major paediatric cancer centres and emergency departments across Australia and New Zealand. If the clinical decision rule is successfully externally validated, this project will implement the paediatric FN pathway nationally as well as develop an AMS program for pediatric cancer centres.

Immunology

This project aims to validate an innovative template of personalised infective risk prediction using the host immune profile.

Primary supervisors: Marc Pellegrini and Ben Teh

Host immunology potentially can identify those at risk for serious infection. T cell subsets, T cell function in response to common pathogens are important in quantifying infection risk but have not yet been incorporated into risk assessment models used by clinicians. We have pioneered a research framework incorporating the clinical assessment for risks and patterns of infection and concurrent immunological profiling at pre-defined points during cancer therapy to allow correlation and to develop algorithms for risk prediction. Our pilot study has successfully identified NK cell and TNF-α levels as significant immunological markers that predict subsequent risk of infection over 3 months. Further refinement and validation of immune profiling in a larger patient cohort is now required.

Allergy

This project aims to assess the impacts of such ‘de-labelling’ on antimicrobial prescribing, with subsequent translation into routine practice.

Primary supervisors: Jason Trubiano and Monica Slavin

We have previously demonstrated that the national inpatient antibiotic allergy “label” (AAL) prevalence to be highest amongst immunocompromised hosts (24%) (1). AALs are associated with increased restricted antibiotic usage and inferior antimicrobial appropriateness and patient outcomes (2). In other centres, such AALs have been associated with higher mortality and the generation of antimicrobial resistance (3, 4). A recent assessment of Australasian antibiotic allergy services by the Australian and New Zealand Survey of Antibiotic Allergy Practices, demonstrated a service ‘gap’; 43% respondents currently without antibiotic allergy services. Moreover, 94% of respondents suggested they would utilize antibiotic allergy services, and felt that they would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (AMS) initiatives (79%, 69% and 61%, respectively). The introduction of pilot antibiotic allergy “de-labeling” clinics at PMCC and Austin Health, utilizing successful protocols (5), to date has ensured that 89% of referred patients have had their allergy “labels” revised or removed. This project will assess the impacts of such ‘de-labeling’ on antimicrobial prescribing and develop a novel implementation toolkit.

Developing models of care

This project will lead the national implementation of the Cancer Sepsis Pathway with a formal implementation program with resources for process mapping, gap analysis, pathway adaptation including for electronic systems, and program evaluation. A REDCAP database is being developed to support data collection across sites. A health outcome and economic evaluation is currently underway to evaluate the utility of sepsis monitoring in cancer patients by quality assurance programs such as Health Round Table.